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  • Time to Act: CMS Proposes Significant 8% Cut to Physical Therapy in 2021

    [Editor’s Note: Response to CMS about the proposed PFS has been strong, and the more comments CMS receives the more likely they are to consider our recommendations. Use this prewritten template letter to add your voice by the September 27 deadline and strengthen our message even more.]

    In this review: APTA's response to a CMS plan to cut Medicare physician fee schedule (PFS) reimbursement for physical therapy providers by 8% beginning in 2021. The reduction for 2021 is included in the proposed 2020 PFS.
    Proposed 2020 Physician Fee Schedule (see table 111, p 1187)
    CMS Fact Sheet
    CMS press release

    The big picture: a proposed 8% cut in Medicare reimbursement for physical therapy providers in 2021
    Deep within the proposed 2020 PFS, CMS reveals a plan that puts Medicare beneficiary access to physical therapy at risk by way of an estimated 8% cut to fee schedule reimbursement in 2021. CMS says the reductions, which affect multiple providers to different extents, are driven by changes to reimbursement formulas for evaluation and management (E/M) services furnished by physicians and some other providers.

    APTA's message to CMS: significant cuts to fee schedule reimbursement for physical therapy providers will put challenging and likely unsustainable financial pressures on physical therapists (PTs), particularly in rural and underserved areas where access is already limited. As more PTs feel this pressure and opt out of treating Medicare beneficiaries—or close their doors altogether—patient access to care will suffer.

    "The changes to reimbursement for office/outpatient E/M codes itself are positive ones and we fully support access to primary care services, but the idea that these changes must be accompanied by deep cuts to other crucial services is outrageous," said Kara Gainer, APTA's director of regulatory affairs. "At a time when our aging population is in need of greater access to physical therapy, with its proven benefits and track record for reducing overall costs, CMS has instead decided to turn its back on the facts and put patients at risk."

    What we're doing—and what you can do (before September 27)
    We're preparing a formal comment letter to CMS, but that's just a part of APTA's efforts. Because the proposal affects multiple providers, from PTs and occupational therapists to clinical social workers, clinical psychologists, ophthalmologists, optometrists, and chiropractors, we're circulating a provider organization sign-on letter objecting to the cuts, and we're working with the American Occupational Therapy Association to develop an additional sign-on letter to be circulated among members of Congress.

    Even more important, we're urging APTA members to bring their individual voices to bear on this issue. We've created a customizable template letter that makes it easy to let CMS know how these proposed cuts will pose a real danger to Medicare beneficiaries and negatively impact PTs' ability to practice under Medicare. Make sure you get your comments to CMS by the September 27 deadline (the template letter includes instructions on how to submit to CMS).

    Tip: this letter is the second template letter we've created in response to the 2020 PFS. The first addresses the problematic physical therapist assistant/occupational therapy assistant coding modifier plan, and is still available for download. If you haven't yet completed and submitted that letter, you can combine it with the letter on the reimbursement cuts.

    What's next
    Deadline for comments is September 27, and the final rule will likely be issued by November 1. In addition to the sign-on letters described above, APTA and several other provider associations will meet with CMS officials in mid-September to share concerns and provide recommendations on a range of issues related to the PFS.

    APTA Launches New ‘Find a PT’ and ‘ChoosePT.com’ Website to Support Consumer Awareness

    Every day, people choose physical therapy for a multitude of reasons, from managing pain to building healthy lifestyle habits. Now APTA's consumer-focused website has a new name—and a new look—to support that reality and help connect patients with physical therapists (PTs) through an enhanced "Find a PT" feature.

    This week, APTA unveiled ChoosePT.com, a consumer website that replaces MoveForwardPT.com, now retired after 10 years. The new site is a best-of-both-worlds combination of 2 of the association's most high-profile and far-reaching initiatives—APTA's popular online source for consumer-oriented health information, now operating under a name that leverages the power of the association's award-winning opioid awareness campaign. The ChoosePT site is expected to receive more than 4 million visitors in 2019, with anticipated increases in the coming years.

    The transition to ChoosePT does not significantly change the content on the former MoveForwardPT site, which still includes information on symptoms and conditions, prevention, and pain management, as well as access to podcasts and videos that deliver powerful messages about the difference physical therapy can make in people’s lives.

    But not everything's the same: The changeover has allowed APTA to make improvements to the site's "Find a PT" directory, an APTA member benefit for physical therapists, that makes it easier for consumers and other providers to filter results by practice focus or specialization.

    The upgraded feature is an opportunity that members shouldn't miss, according to Jason Bellamy, APTA's executive vice president of strategic communications.

    “Millions of people will visit ChoosePT.com this year, and one of their most common destinations will be Find a PT," Bellamy said. "APTA members should ensure their information is up-to-date, and add a headshot to make their profile more appealing. Our message to members is, 'do everything you can to help consumers choose you.'"

    ChoosePT.com is also enhanced by geolocation technologies that, with a user's permission, create an online experience customized to the user's physical location. APTA state chapters that have an active geolocation page—49 to date—can add state-specific information to the ChoosePT site, providing visitors with an additional depth of relevant information.

    Bellamy believes the change to ChoosePT.com is the right move at the right time, with more exciting changes coming around the corner.

    “When we launched our opioid awareness campaign we knew our #ChoosePT message was dynamic enough to extend beyond the safe management of chronic pain,” Bellamy said. “With APTA’s centennial approaching in 2021, and the public awareness opportunities that will provide, this was the perfect time to make that our primary call to action.”

    Want t-shirts with the new ChoosePT logo? They're available here.

    'Fundamentally Flawed': APTA's Comments on CMS' Plan Around PTAs, OTAs Target Potential Harms

    The big picture: a bad plan for determining when services are delivered by a PTA or OTA
    The US Centers for Medicare and Medicaid Services' (CMS) proposed physician fee schedule rule for 2020 includes provisions that would require providers to navigate a complex system intended to identify when outpatient therapy services are furnished by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). If adopted, the plan would trigger a payment differential in 2022 based on how many minutes of services are provided by the PTA or OTA. (See this PT in Motion News story for a more detailed overview of the proposed rule.)

    CMS proposes to accomplish this by way of new PTA and OTA modifiers (CQ and CO, respectively) to be included on claims beginning January 1, 2020. The proposal also requires providers to add a statement in the treatment note that explains why the modifier was or wasn't used for each service furnished that day. In short, the system is rooted in total minutes of service, and would require the use of the applicable modifier that would indicate when a PTA or OTA provided outpatient therapy services for 10% or more of the total time spent furnishing the service.

    The proposal is more than just problematic—it's a threat to patient access to care, a vast overreach of CMS authority, and a documentation nightmare that flies in the face of CMS' "patients over paperwork" initiative to ease administrative burdens on providers. We laid out our concerns in a comment letter to CMS that describes the plan as "fundamentally flawed."

    Some of what's being proposed, CMS reasoning behind it—and what we have to say

    CMS: When the PTA participates in the service concurrently with the PT for a portion of total time, the modifier should be used when the minutes furnished by the therapy assistant are greater than 10% of the total minutes spent by the therapist furnishing the service, which means that the entire service would be subject to the 15% payment adjustment in 2022. This is being done to comply with Section 1834(v) of the Social Security Act.
    APTA: The intent of the therapist assistant provisions in the Social Security Act was to better align payments with the cost of delivering therapy services given that therapist assistant wages are typically lower than therapist wages. It was not meant to apply an adjustment to a PT's services furnished when the therapist assistant provides a “second set of hands” to the therapist for safety or effectiveness.

    The proposal completely ignores the efficacy of team-based care (CMS uses the term “concurrent“) and runs counter to the evolution—ostensibly supported by CMS—toward value-based care. "It is nonsensical to diminish reimbursement for services when safety precautions are implemented, and the overall value of the care is increased," we say in our letter. Bottom line: only services furnished in whole or in part independently by the assistant should count toward the 10% standard.

    CMS: If the PTA and the PT each separately furnish portions of the same service, the modifier would apply when the minutes furnished by the PTA are greater than 10% of the total minutes—the sum of the minutes spent by the therapist and therapy assistant—for that service.
    APTA: This proposal directly contradicts CMS' response to comments in the 2019 fee schedule final rule. In the rule, CMS explained how its claims processing system allows for the differentiation of the same procedure code when the same service or procedure is furnished separately by the therapist and assistant.

    In our letter, we write that “the agency clearly is contradicting itself now, several months later, in proposing to require that the CQ/CO modifier apply when the minutes furnished by the assistant are greater than 10% of the total minutes—the sum of the minutes spent by the therapist and therapist assistant for that service, thereby not allowing for the same procedure code to be reported on 2 different claim lines.”

    But that's just part of the problem. The system CMS is proposing for how providers arrive at this is anything but simple—in fact, we say that it's "outrageous that CMS expects therapy providers—particularly those who do not employ administrative staff and must perform all the coding and billing themselves in addition to delivering treatment to patients—to engage in division, addition, multiplication, and rounding merely to determine whether to affix a modifier to the claim."

    CMS: Beginning in 2022, if the PTA services exceed the 10% limit, reimbursements will be cut by 15%.
    APTA: The cuts pose a grave threat to the delivery of services, particularly in rural and underserved areas, especially when it's combined with the geographic indices that affect payment in these areas—on top of other potential reimbursement reductions in future years. We recommend that if CMS moves ahead with this proposal, it should exempt providers in rural and underserved areas from the requirements.

    CMS: In addition to the use of new modifiers, providers will need to provide a written statement explaining why the modifier was or wasn't used—and it has to be done for each service furnished that day.
    APTA: In our letter we call this plan "wholly unbelievable." Aside from the facts that the modifier proposal itself is extremely complicated and the extra documentation is not required by law, the addition of a statement requirement is clearly an undue administrative burden and a direct contradiction of the CMS "Patients Over Paperwork" initiative.

    We write that the plan "conveys a sense that CMS is being vindictive toward outpatient therapy providers, creating a divisive environment for therapy providers enrolled in the Medicare program." Our comment letter goes on to provide 6 additional reasons why the documentation requirement is a bad idea, including the ways in which it complicates 15-minute timed billing, exceeds requirements of Medicare administrative contractors, and applies a standard to PTs, OTs, PTAs, and OTAs that isn't applied to physicians, physician assistants, and nurse practitioners.

    What's next?
    This letter is the first of 2 comment letters on the fee schedule that APTA will be providing to CMS in the coming weeks. Deadline for comments is September 27, and the final rule will likely be issued by November 1. APTA and several other providers associations will be meeting with CMS officials in mid-September to share concerns and provide recommendations.

    You have an important role to play. Visit APTA's "Regulatory Take Action" webpage to access a customizable template letter on the PTA/OTA modifier, fill it in, and make your voice heard. It's easy—and crucial.

    Stay tuned for additional opportunities for comment on other elements of the proposed rule.

    4 Videos (and a Podcast) to Get You Ready for Pain Awareness Month

    September is National Pain Awareness Month—a perfect opportunity to spread the word about the important role physical therapists (PTs) and physical therapist assistants (PTAs) play in the management of pain, and the unique knowledge they bring to the table.

    Need a reminder of why patient access to physical therapy for pain is so crucial, or inspiration to get you thinking about your own activities during National Pain Awareness Month? Here are some standout videos—and a podcast—that do just that. All but 1 were produced by APTA.

    A Journey Out of Pain and Addiction, and a PT's Crucial Role
    What it's about: In his keynote address for the 2019 APTA NEXT Conference and Exhibition, US Army Master Sergeant (Retired) Justin Minyard recounted the injuries he received during rescue attempts first at the Pentagon during the 9-11 attacks and then while on a mission in Afghanistan. But the heart of Minyard's story is about what happened afterward: the multiple fusion and other surgeries, the intense pain, his slide into addiction, and his eventual freedom from opioids. He readily acknowledges that his recovery was thanks in large part to the work of an interprofessional team that included a dedicated physical therapist.

    Why you should listen: Minyard's brutal honesty and his ability to tell a story with both humor and pathos pull you in from the start. And the gratitude he has for his PT—he describes her as not just his physical therapist "but my psychologist, my sounding board, my marriage counselor, my educator of my options, and my kick in the ass"—will remind you of why you love the profession.

    Beyond Opioids: Transforming Pain Management to Improve Health
    What it's about: This video of a February 2018 Facebook Live panel discussion hosted by APTA provides a wide range of perspectives on physical therapy's role in pain management. Panelists include a patient advocate, a representative from the US Centers for Disease Control and Prevention, a member of the US House of Representatives, the President of the American Academy of Pain Medicine, and 2 PTs working on the front lines of pain management.

    Why you should watch: It's fascinating to watch the ways in which panelists' individual perspectives weave a unified message: that there's a need for increased and more open communication, better identification of risk factors for opioid abuse, greater use of multidisciplinary approaches to pain management, and more education delivered to patients, providers, employers, and entire communities.

    Congressional Briefing on Treating Pain
    What it's about: This video, a straightforward recording of an APTA-sponsored Congressional briefing held in May 2019, makes the case for better policy support for nonpharmacological approaches to pain management through the perspectives of 2 PTs and Cindy Whyde, a high school teacher whose son Elliot struggled with opioid addiction after receiving the drugs for a football injury.

    Why you should watch: Cindy Whyde's story is a heartbreaking (and frustrating) testimony to how far the health care system still has to go when it comes to patient education on and access to nondrug pain management approaches. Jen Bambrough, PT, DPT, and Sarah Wenger, PT, DPT (Wenger was also a panelist for the Facebook Live event), discuss how more thoughtful, collaborative, and patient-centered strategies can and do work.

    How Physical Therapy is Helping to Fight the Opioid Crisis
    What it's about: In September 2018, Prevention magazine editor Sarah Smith interviewed Sarah Wegner, PT, DPT, about the ways PTs and PTAs can help patients explore nonpharmacological management of pain.

    Why you should watch: It's a great interview aimed at a general audience, and Wenger is articulate and passionate about the profession. The half-hour program also explores the training, knowledge, and skills PTs must acquire, and why this combination is so well-suited to pain management. A great intro to physical therapy for the consumer—particularly the consumer struggling with pain.

    "You've Got No Bigger Fan Than the Surgeon General"
    What it's about: This APTA interview with US Surgeon General Jerome Adams, MD, MPH, took place just after he finished an address at the association's Component Leadership Meeting in January 2019. Adams' address at the meeting amounted to a resounding endorsement for physical therapy as a key player in the battle against pain and the opioid crisis. The video interview afterwards recaps his main points.

    Why you should watch: It never hurts to have friends in high places, and Adams is an enthusiastic supporter of physical therapy. His commitment to bringing the profession to the table, pressing for more multidisciplinary approaches to pain and addiction, and bringing the message of responsible opioid stewardship into communities comes through loud and clear.

    [Editor's note: stay tuned for more APTA activities during National Pain Month coming up in mid-September,]

    Stay Inspired, Motivated, and In-the-Know With These APTA Podcasts

    APTA continues to assemble a collection of free, easy-to-download podcasts that deliver plenty of variety, from personal stories that remind you of why you love what you do, to nuts-and-bolts information that could be crucial to your professional survival.

    Where to start? Here are some suggestions—but you can also check out APTA's podcasts webpage to browse an extensive list of offerings.

    Podcasts that inspire
    A recent example: "A Journey Out of Pain and Addiction, and a PT's Crucial Role"

    What it's about: In his keynote address for the 2019 APTA NEXT Conference and Exhibition, US Army Master Sergeant (Retired) Justin Minyard recounted the injuries he received during rescue attempts first at the Pentagon during the 9-11 attacks and then while on a mission in Afghanistan. But the heart of Minyard's story is about what happened afterward: the multiple fusion and other surgeries, the intense pain, his slide into addiction, and his eventual freedom from opioids. He readily acknowledges that his recovery was thanks in large part to the work of an interprofessional team that included a dedicated physical therapist (PT).

    Why you should listen: Minyard's brutal honesty and his ability to tell a story with both humor and pathos pull you in from the start. And the gratitude he has for his PT—he describes her as not just his physical therapist "but my psychologist, my sounding board, my marriage counselor, my educator of my options, and my kick in the ass"—will remind you of why you love the profession.

    More inspiration: APTA's "Defining Moment" podcast series is the audio companion to PT in Motion magazine's regular feature of the same name, which highlights stories from members about those moments when they felt that special—often life-changing—connection to the physical therapy profession. [Editor's note: If you want to share your defining moment, contact Associate Editor Eric Ries at ericries@apta.org.] For inspiration you can share with your patients, the popular Move Forward Radio is your go-to option: an interview series that features patients, PTs, and physical therapist assistants (PTAs) discussing physical therapy's role in a wide range of issues. Recent podcasts include explorations of physical therapy and people with Alzheimer's disease, foot health, and the treatment of pelvic pain in people who are transgender.

    Podcasts that energize
    A recent example: Just about any podcast from the APTA Pulse series

    What they're about: Some of the liveliest discussion in the profession is taking place at the student level, and the APTA Pulse series of blogs and podcasts brings that energy to you. The Pulse podcast series features mostly students, with the occasional more-seasoned PT, PTA, or other expert. Notable podcasts include "Failure Is a Bruise, Not a Tattoo," "Stereotype Threat," and "Healthy Mental Living: Tips From a Counseling Psychologist."

    Why you should listen: It's a great way to re-charge your enthusiasm for the profession.

    More energy: Want more insight on the PT and PTA student perspective? APTA's Student Assembly records its "#XchangeSA" live chats, which have ranged from discussions about performance therapy and training to building your professional brand. And if you haven't read or heard it already, APTA President Sharon Dunn's address to the 2019 APTA House of Delegates will put some wind in your sails when it comes to the challenges of taking on the high cost of PT and PTA education, dismantling the productivity mindset, and making involvement in the association accessible to all.

    Podcasts that inform
    A recent example: "Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis"

    What it's about: In this interview for APTA's journal PTJ (Physical Therapy), Editor-in-Chief Allan Jette, PT, PhD, FAPTA, interviews researcher Aaron Keil, PT, DPT, about his groundbreaking study on civilian PTs who are able to order imaging.

    Why you should listen: Don't be scared off by the academic-sounding title. With the growth of direct access to PT services comes more serious discussion about the PT’s role in primary care—and the importance of the PT's ability to order diagnostic imaging as a crucial part of that primary care role. It's an issue that needs to be on your professional radar.

    More information: Each month PTJ produces podcasts, like the one highlighted above, that help you get a first-person perspective on some of the latest research in the profession, making the PTJ podcast page worth a regular stop. Another helpful research-oriented podcast: easy-to-follow expert tips on finding evidence and research on APTA's PTNow Article Search and Rehabilitation Reference Center.

    And even more information: If you're interested in keeping up with fast-moving world of payment (particularly related to Medicare and Medicaid), don't miss APTA's "Insider Intel" recordings of its live phone-in series. You won't find Insider Intel on the association's podcast page—they're collected separately—but they're definitely worth tracking down. MIPS, SNF payment, home health rules, new payment models, the physician fee schedule—it’s all there. And you can register for upcoming live events while you're checking out the recorded ones.

    APTA Working for You: Commercial Payer Updates, July 2019

    The commercial payer world is varied and continually evolving. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of private payer-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    The results of an APTA survey on administrative burden are in
    APTA highlights the results of a 2018/2019 survey on administrative burden in a new infographic. The survey revealed significant concerns from PTs and PTAs, particularly around the impact excessive requirements are having on clinical outcomes. A summary report on the findings is also in the works.

    The survey and infographic will be the subject of a presentation on administrative burden at the 2019 APTA Insurers' Forum. APTA encourages members to review the infographic and summary (when it's released) and use the resources in discussions with payers and other stakeholders.

    OSHA responds to APTA by affirming the PT's role in first aid
    In response to a meeting with APTA and our subsequent request for clarification, the US Department of Labor Occupational Safety and Health Administration (OSHA) issued a statement affirming that in workplace injury incidents, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART). Details on the clarification, which is good news for physical therapists, can be found in this PT in Motion News story.  

    Use of third-party administrators is growing—and staying on top of the changes will require communication
    APTA continues to track the increased use of third-party administrators to manage the physical therapy benefit as national payers implement systems regionally with the intent to include all states and lines of business over time.

    APTA and its chapters collaborate and coordinate efforts to mitigate adverse patient impacts and provider administrative burden related to utilization management (UM) vendors. At the same time, the association seeks to develop a working relationship with payers and UM vendors to advocate for members when issues arise. Those efforts are strengthened through members' ongoing communication with APTA. Download this step-by-step guide for tips on when and how to report new or significantly changed UM programs.

    APTA's work with eviCore is increasing provider access to information
    Utilization management firm eviCore has made it easier for providers to find provider engagement staff assigned to their geographic area. The list, available as a pdf document on the eviCore website, is among the resources available on the company's "training resources" webpage.

    Front-end claim edits are on the rise
    Front-end edits—when a payer automatically denies a claim with a certain profile, forcing the provider to appeal the denial and provide documentation supporting the appeal—are being implemented by several payers and third-party administrators. For PTs, the most frequent trigger for a front-end edit is the use of the 59 modifier.

    APTA has taken several steps to address this issue, including asking the US Centers for Medicare and Medicaid Services (CMS) to remove edits associated with codes commonly used by PTs, engaging commercial payers in discussions about challenges associated with these edits, and providing resources to providers, including this infographic on use of the 59 modifier. APTA urges providers to consult with the association about appropriate use of the 59 modifier, and to follow through with the appeals process if documentation supports its use. Appeals can make a difference—Aetna has already indicated that if the turnover rate on appeals is high for a particular type of claim, the front-end edit will be removed.

    An APTA-sponsored session at a self-insurers' conference focused on the PT's role in population health
    APTA member Michael Eisenhart, PT, presented an APTA-sponsored session titled “Population Health: How Physical Therapists Can Help Your Employees” at the 2019 National Council of Self Insurers annual conference in June. Eisenhart's presentation showcased the role of physical therapy in the workplace and emphasized its potential for employers who self-insure their workers' compensation programs.

    Workers' Compensation programs are evolving in positive ways
    APTA has observed a greater recognition among workers' compensation (WC) programs that physical medicine not only helps address musculoskeletal issues, it also promotes patient participation in recovery and self-management and reduces the risk of reinjury. While overall injury rates and frequency have been declining, the percent of claims with physical medicine involvement have increased by 13%.

    Ohio is an example of the how this shift is playing out. In 2018, the Ohio Bureau of Workers’ Compensation mandated 60 days of conservative care before the authorization of lumbar fusion surgery. Accordingly, a national WC third-party administrator reported a rise in nonsurgical physical therapy referrals, with an attendant drop in surgical referrals—from 11% in 2017 to 5% in 2018.

    New York is also embracing the value of physical therapy in WC. The New York Workers’ Compensation Bureau (NYWCB) adopted a revised fee schedule in October 2018 that became effective on April 1, 2019. NYWCB increased the relative value units (RVUs) to 18 for evaluations and 15 for reevaluations. The bureau also raised RVUs from 8 to 12 for follow-ups. The net result of this change, plus the fee schedule increase, will result in payment increases. APTA's New York Chapter provides a detailed accounting of the changes.

    APTA, AOTA, and ASHA create a guide to assessing habilitation and rehabilitation benefits
    APTA, together with the American Occupational Therapy Association (AOTA) and American Speech-Language-Hearing Association (ASHA), collaborated to create a guide to assessing habilitation and rehabilitation benefit adequacy that emphasizes transparency, access, and affordability. Available on APTA's Essential Health Benefits webpage, the guide forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services.

    Anthem's transition to a new UM vendor in 13 states is still on, but delayed
    Anthem Blue Cross-BlueShield is moving ahead with its use of utilization management (UM) vendor AIM Specialty Health in 13 states, but technical issues have delayed implementation.

    Providers who bill Anthem in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin can still expect to be required to use the new vendor in the near future—Anthem says it will update providers toward the end of July on when actual implementation will occur

    In the meantime, APTA urges providers in the impacted states to participate in vendor-sponsored training available through the AIM Rehabilitation Provider Portal. If you experience difficulty enrolling in training or other problems, inform your APTA chapter.

    APTA offers a range of resources for learning more about commercial payment and staying connected: sign up for the Coding, Billing, and Payment online community to join the conversation and share experiences; stay informed by visiting APTA's commercial insurance webpage to access information and download tools including customizable appeals letters; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Have questions or want to make your voice heard in local, state, and national advocacy? Email advocacy@apta.org.

    APTA-Backed Bill to Provide Diversity-Based Scholarships, Stipends Introduced in House

    APTA's efforts to create a physical therapy profession as diverse as the society it serves could be getting a significant legislative boost: a new bill introduced in the US House of Representatives seeks to provide $5 million per year in scholarships and stipends aimed at increasing the number of students from underrepresented populations in physical therapy and other allied health education programs.

    Introduced by Reps Bobby Rush (IL) and Cathy McMorris Rogers (WA), the Allied Health Workforce Diversity Act of 2019 would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. APTA, the American Occupational Therapy Association (AOTA), the American Speech-Language-Hearing Association (ASHA), and the American Academy of Audiology (AAA) were instrumental in crafting language for the bill.

    The legislation falls squarely in line with APTA's strategic plan, which identifies greater provider diversity as necessary to ensure the long-term sustainability of the physical therapy profession.

    "We must build a diverse profession by ensuring there are opportunities that allow for inclusion of all individuals who want to become physical therapists and physical therapist assistants," said APTA President Sharon Dunn, PT, PhD, in a joint news release issued by APTA, AOTA, ASHA, and AAA. "The population we serve is evolving and becoming more diverse. We know that patients who receive care from providers who share their racial and ethnic backgrounds tend to respond better to treatment. That's one reason this legislation is so important, and we applaud the representatives who have introduced it."

    APTA government affairs staff will track the bill's progress and share opportunities for grassroots advocacy. The association will add information to its Legislative Action Center later this week for members to use to support the legislation.

    APTA Survey: PTs Say Administrative Burdens Delay Access, Affect Clinical Outcomes

    Think that administrative burdens are hurting your ability to provide the best possible care? You're not alone: results of a recent APTA survey of physical therapists (PTs) nationwide reveal that nearly 3 in 4 believe that overreaching documentation and administrative mandates negatively affect patient outcomes—and 8 in 10 point to excessive requirements as a contributor to clinician burnout.

    The results are now part of an infographic that helps with the association’s efforts for legislative and policy changes to rein in excessive requirements around areas including prior authorization and claim denial appeals. Among the findings:

    Prior authorization requirements delay care and affect clinical outcomes.

    • Three quarters of respondents said that prior authorization requirements delay access to medically necessary care by 25% or more.
    • 72% of survey participants estimated that they wait at least 3 days for a prior authorization decision from an insurer.
    • Just over 1 in 4 respondents said that the wait time is usually more than a week.
    • Approximately 3 in 4 PTs agreed or strongly agreed that prior authorization requirements negatively impact patients' clinical outcomes.

    Claim denial appeals are time-consuming (and often contradictory).

    • 40% of respondents told APTA that payers who say they don't require prior authorization later deny approximately 25% of claims for lack of prior authorization.
    • 65% of PTs said that it takes more than 30 minutes of staff time to prepare an appeal for 1 claim.
    • When it comes to rates of claim denials, appeals, and final dispensation, respondents estimated that 13% of filed claims are denied; of that 13%, 66% are appealed. And in the end just over half of the appeals—52.34%—are overturned.

    Administrative burden is adding to cost—and burnout.

    • The survey revealed that large percentages of both front desk staff and clinicians spend more than 10 minutes per patient requesting approval for continued visits, ranging from 64.6% of clinicians working with Medicaid fee-for-service beneficiaries, to 77.3% of front desk staff requesting continued visits for Medicaid managed care patients.
    • More than three-quarters of facilities—76.5%—reported that they've had to add nonclinical staff to handle administrative burden.
    • 85.2% of respondents agree or strongly agree that administrative burden contributes to clinician burnout.

    As for what changes would make the most difference, just over half of respondents believe that standardizing documentation requirements would be a big help. Other popular adjustments were elimination of the requirement for the Medicare plan of care signature and recertification (38.8%), standardization of coverage policies across payers (38.1%), unrestricted direct access (36.1%), and standardization of the prior authorization process (36%).

    "APTA has long argued that excessive administrative burden negatively impacts care—what's important about this survey is the consistency of responses and the level of shared perception among PTs who experience this issue every day," said Kara Gainer, APTA director of regulatory affairs. "Administrative burden isn't a nebulous issue for providers—it is a very real barrier to delivering care, with identifiable pain points and very specific areas in need of change."

    The association continues to place the reduction of administrative burdens high on its advocacy list and has again identified the issue as among it 2019-2021 public policy priorities. One recent opportunity: a request for information (RFI) from the US Centers for Medicare and Medicaid Services (CMS) on reducing administrative burden. APTA will provide comments by the August 12 deadline and has made it easy for individual clinicians to submit comments by way of a template letter that can be personalized to suit specific circumstances. APTA is also developing a template letter that can be used by patients and will post a link to it on the association's regulatory "take action" webpage.

    At the same time, a legislative advocacy opportunity emerged in the form of a congressional bill aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers. Known as the "Improving Seniors' Timely Access to Care Act of 2019," (H.R. 3107), the bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA). APTA staff will add information to the Legislative Action Center in the coming weeks for members to use to advocate in support of this legislation.

    “Current prior-authorization programs hinder patient access to medically necessary services and must be modified,” said Katy Neas, APTA executive vice president for public affairs. "But this is just 1 element of the wider administrative burden issue, and APTA will continue to advocate for change on multiple fronts."

    OSHA Responds to APTA by Affirming the PT's Role in First Aid

    When it comes to workplace injury, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART): that's the bottom-line message from the US Department of Labor Occupational Safety and Health Administration (OSHA) in response to APTA’s request for OSHA clarification on the subject. The OSHA response definitively establishes physical therapists (PTs) among the providers able to perform soft tissue interventions that constitute first aid in work settings.

    The OSHA clarification is a response from a February 2019 meeting secured by APTA government affairs staff in partnership with the APTA Academy of Orthopaedic Physical Therapy’s Occupational Health Special Interest Group and the APTA Private Practice Section. It clears up a previously foggy area of agency regulation involving what is and isn't considered "medical treatment beyond first aid" in the workplace—an important distinction for OSHA, as any treatment beyond first aid must be reported as a work-related injury or illness.

    While the regulations state that "using massages" is considered first aid, APTA pointed out that previous OSHA guidance recognizing ART as a soft tissue intervention led some employers to mistakenly believe that only ART-certified individuals could provide “massage.” APTA asked OSHA to confirm in writing that soft tissue management is considered first aid when it is performed by individuals who do not have ART certification—including non-ART-certified PTs.

    OSHA did just that.

    "OSHA considers the treatments listed in…the regulation to be first aid regardless of the professional status of the person providing the treatment," writes Amanda Edens, director of OSHA's Directorate of Technical Support and Emergency Management. "Even when these treatments are provided by a physician or other licensed health care professional, they are still considered first aid for purposes of [the regulation in question]." Edens went on to state, “Accordingly, soft tissue massage is first aid whether or not such treatment is performed by individuals with ART certification.”

    The letter from OSHA also made it clear that the approach to recording soft tissue injuries and illnesses is the same as any other type of injury or illness, meaning that work-related injuries and illnesses "involving muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs" do in fact meet the general recording criteria if they involve medical treatment beyond first aid, days away from work, transfer, or restricted work.

    "Although this may seem like a minor clarification, it's a great win for PTs," said Kara Gainer, APTA director of regulatory affairs. "It's another affirmation that PTs play a valuable role in workplace health and safety, and can be an important part of employer prevention and wellness teams."

    Want more on the potential for PTs to contribute to population health in the workplace? Check out APTA's webpage "The PT's Role in Promoting a Productive and Healthy Workforce."

    From PT in Motion Magazine: The Power of Adaptive Sports

    Adaptive sports are on the move as a popular way for individuals with physical disabilities to reclaim—and, sometimes discover—their love for physical activity. Do physical therapists (PTs) and physical therapist assistants (PTAs) need to catch up?

    In "The Competitive Edge of Adaptive Sports," featured in the June issue of PT in Motion magazine, Associate Editor Eric Ries examines the ways participation in the modified sports has changed the lives of several individuals—some of whom are PTs—who believed their injuries would forever prevent them from taking part in their favorite activities, such as basketball, cycling, and surfing. When they discovered the possibilities available through adaptive sports programs and leagues, a world they thought was closed to them was reopened.

    However, despite the growing prominence of adaptive sports, many feel that PTs and PTAs are behind the curve when it comes to having sufficient experience and understanding to help patients participate in the programs, according to the article.

    "Still in its infancy" is how Katie Lucas, PT, DPT, chair of the APTA Academy of Sports Physical Therapy's Adaptive Sports Special Interest Group, describes the profession's role in adaptive sports to PT in Motion. "There's a lot of room for growth in research and in terms of identifying and taking advantage of all the ways in which adaptive sports fit into physical therapist practice, enhance wellness, and expand opportunities for patients."

    The article plumbs the possible reasons behind the general lack of awareness, with PTs familiar with adaptive sports offering ideas for changes in physical therapy education programs that would familiarize students with the potential value of the programs. Some of those changes could be as simple as merely exposing students to an adaptive sporting event, they say, but the payoff could be significant for patients and providers.

    Maria Thomassie, PT, DPT, can attest to the benefits of understanding adaptive sports. She tells PT in Motion that being involved in adaptive sports has shed light on "how far we've come in creating an accessible world but how much further we have to go," adding that "there are insights to be gained by PTs and PTAs regardless of practice area."

    "The Competitive Edge of Adaptive Sports" is featured in the June issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: "Let Her Roll," a look at how PTs help roller derby athletes compete in the rink.